Early switch from anti-VEGF Therapy to dexamethasone implant in diabetic macular edema

Abstract

Diabetic retinopathy (DR) is the one of severe complications of diabetes, associated with macular edema (DME), which is the main course of visual acuity loss in diabetic patients. The main pathological factors in diabetic retinopathy and diabetic macular edema (DME) are the inflammation and increasing of vascular endothelium growth factor activity (VEGF). The treatment of DME remains challenging during the times. We know that not all eyes respond optimally to anti-VEGF therapy. No clinical effect or minimal one among patients with persistent DME has led to an urgent need to develop new treatment protocols for this group of patients. In this case adding intravitreal corticosteroids to the treatment regimen is the most effective and predictаble than continued anti-VEGF therapy alone. According to results of randomized trials the functional and anatomical outcomes in eyes with refractory DME, which were switched to DEX implant had shown statistically significant better outcome, compared to anti-VEGF therapy alone. Another important question is efficiency and safety of using intravitreal corticosteroids as the first-line therapy in patients with DME. These new findings can help to define better the role of early switch to DEX implant in the current treatment algorithm of eyes with refractory DME. And find the optimal protocol of treatment patients with DME, determine the predictors of switching from anti-VEGF therapy to steroid intravitreal injections, in DME should be on the agenda of the future studies.

Keywords

• anti-vegf
• dme
• early switch
• implant dexamethasone